Thyroid hormone and its metabolites in relation to quality of life in patients treated for differentiated thyroid cancer
Abstract
Summary: Background: Levothyroxine (LT 4) is the standard of care in patients with hypothyroidism. Despite this replacement therapy, quality of life (QoL) remains impaired in a substantial amount of patients. The reasons for this are still a matter of debate. Suggested causes include lack of endogenous T3 secretion by the thyroid, changes in other thyroid hormone metabolites and interference by autoimmune processes. Objective: To investigate the association between thyroid function tests (TFT s) and QoL in patients with a history of differentiated thyroid cancer on LT 4 monotherapy. These patients lack endogenous thyroidal T3 secretion in the absence of autoimmune disease. Materials and Methods: This is a cross‐sectional study in 143 patients (69·2% female). Initial therapy consisted of total thyroidectomy followed by radioiodine ablation minimally one year before inclusion. We assessed health‐related QoL (RAND‐36), thyroid‐specific QoL (Thy PRO) and fatigue with the Multidimensional Fatigue Inventory. Extensive TFT s were assessed, including 3,5‐diiodo‐L‐thyronine (3,5‐T2). Results: Mean age was 50·2 years and mean time since diagnosis was 8·4 years. Median TSH was 0·042 mU/l, total T4 145·0 nmol/l, free T4 25·6 pmol/l, total T3 1·93 nmol/l, reverse T3 0·53 nmol/l and 3,5‐T2 0·86 nmol/l. Multiple linear regression analyses did not show any association between QoL and the different TFT s, including T4/T3 and 3,5‐T2/T3 ratios reflecting peripheral metabolism. Conclusion: We did not find any association between TFT s and QoL in athyreotic patients on LT 4 monotherapy. Our data do not provide evidence that a slight increase in dose improves fatigue or well‐being in hypothyroid patients on LT 4 therapy.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The observed patterns in sera of the four studies contradict prior observations that higher 3,5-T2 concentrations were observed in thyroidectomized patients on oral T4 replacement therapy.
“However, these observed patterns in sera of these four studies do contradict the above-mentioned observations that higher 3,5-T2 concentrations were observed in thyroidectomized patients on oral T4 replacement therapy (20, 62).”
From 3,5-T2—A Janus-Faced Thyroid Hormone Metabolite Exerts Both Canonical T3-Mimetic Endocrine and Intracrine Hepatic Action (2020) · cites this paper as [62]
Cites
The RAND-36 measure of health-related quality of life
Hays, R. D., & Morales, L. S. (2001) · Annals of Medicine · doi:10.3109/07853890109002089 · Cited by 1,460 · see citing works
Saravanan, P., Chau, W. ‐., Roberts, N., Vedhara, K., Greenwood, R., & Dayan, C. M. (2002) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2002.01654.x · Cited by 514 · see citing works
Bunevičius, R., Kažanavičius, G., Žalinkevičius, R., & Prange, A. J. (1999) · New England Journal of Medicine · doi:10.1056/nejm199902113400603 · Cited by 482 · see citing works
Epidemiology and prevention of clinical and subclinical hypothyroidism.
Vanderpump, M. P. J., & Tunbridge, W. M. G. (2002) · Thyroid · doi:10.1089/105072502761016458 · Cited by 347 · see citing works
Levothyroxine Monotherapy Cannot Guarantee Euthyroidism in All Athyreotic Patients
Gullo, D., Latina, A., Frasca, F., Le Moli, R., Pellegriti, G., & Vigneri, R. (2011) · PLoS ONE · doi:10.1371/journal.pone.0022552 · Cited by 307 · see citing works
Wekking, E. M., Appelhof, B. C., Fliers, E., Schene, A. H., Huyser, J., Tijssen, J. G. P., & Wiersinga, W. M. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.02025 · Cited by 299 · see citing works
Grozinsky-Glasberg, S., Fraser, A., Nahshoni, E., Weizman, A., & Leibovici, L. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0448 · Cited by 296 · see citing works
Escobar-Morreale, H. F., del Rey, F. E., Obregón, M. J., & de Escobar, G. M. (1996) · Endocrinology · doi:10.1210/endo.137.6.8641203 · Cited by 261 · see citing works
Metabolic Effects of Thyroid Hormone Derivatives
Moreno, M., de Lange, P., Lombardi, A., Silvestri, E., Lanni, A., & Goglia, F. (2008) · Thyroid · doi:10.1089/thy.2007.0248 · Cited by 226 · see citing works
Triiodothyronine Levels in Athyreotic Individuals During Levothyroxine Therapy
Jonklaas, J. (2008) · JAMA · doi:10.1001/jama.299.7.769 · Cited by 216 · see citing works
Walsh, J. P., Ward, L. C., Burke, V., Bhagat, C. I., Shiels, L., Henley, D., Gillett, M. J., Gilbert, R., Tanner, M., & Stuckey, B. G. A. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0099 · Cited by 164 · see citing works
Samuels, M. H., Schuff, K. G., Carlson, N. E., Carello, P., & Janowsky, J. S. (2007) · Thyroid · doi:10.1089/thy.2006.0252 · Cited by 124 · see citing works
Watt, T., Hegedüs, L., Bjorner, J. B., Groenvold, M., Bonnema, S. J., Rasmussen, Å. K., & Feldt-Rasmussen, U. (2012) · European Thyroid Journal · doi:10.1159/000342623 · Cited by 75 · see citing works
Weight Changes in Euthyroid Patients Undergoing Thyroidectomy
Jonklaas, J., & Nsouli-Maktabi, H. (2011) · Thyroid · doi:10.1089/thy.2011.0054 · Cited by 69 · see citing works
Padron, A. S., Neto, R. A. L., Pantaleão, T. U., de Souza dos Santos, M. C., Araujo, R. L., de Andrade, B. M., da Silva Leandro, M., de Castro, J. P. S. W., Ferreira, A. C. F., & de Carvalho, D. P. (2014) · Journal of Endocrinology · doi:10.1530/joe-13-0502 · Cited by 69 · see citing works
Samuels, M. H., Kolobova, I., Smeraglio, A., Peters, D., Janowsky, J. S., & Schuff, K. G. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3686 · Cited by 48 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction
Peterson, S. J., Cappola, A. R., Castro, M. R., Dayan, C. M., Farwell, A. P., Hennessey, J. V., Kopp, P. A., Ross, D. S., Samuels, M. H., Sawka, A. M., et al. (2018) · Thyroid · doi:10.1089/thy.2017.0681 · Cited by 231 · see citing works
THERAPY OF ENDOCRINE DISEASE: T4 + T3 combination therapy: is there a true effect?
Wiersinga, W. M. (2017) · European Journal of Endocrinology · doi:10.1530/eje-17-0645 · Cited by 52 · see citing works
Hennessey, J. V., & Espaillat, R. (2018) · International Journal of Clinical Practice · doi:10.1111/ijcp.13062 · Cited by 49 · see citing works
An Exploratory Study of Fatigue and Physical Activity in Canadian Thyroid Cancer Patients
Alhashemi, A., Jones, J. M., Goldstein, D. P., Mina, D. S., Thabane, L., Sabiston, C. M., Chang, E. K., Brierley, J. D., & Sawka, A. M. (2017) · Thyroid · doi:10.1089/thy.2016.0541 · Cited by 27 · see citing works
Köhrle, J., Lehmphul, I., Pietzner, M., Renko, K., Rijntjes, E., Richards, K., Anselmo, J., Danielsen, M., & Jonklaas, J. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00787 · Cited by 23 · see citing works
Self-citationPharmacodynamic and Therapeutic Actions of Levothyroxine
Hennessey, J. V. (2021) · 70 Years of Levothyroxine · doi:10.1007/978-3-030-63277-9_3 · Cited by 4 · see citing works
Diab, N., Desale, S., Danielsen, M., Köhrle, J., Shara, N., & Jonklaas, J. (2022) · Metabolites · doi:10.3390/metabo12060476 · Cited by 1 · see citing works
Self-citation
- Authors
- Massolt, E. T., van der Windt, M., Korevaar, T. I. M., Kam, B. L. R., Burger, J. W., Franssen, G. J. H., Lehmphul, I., Köhrle, J., Visser, W. E., & Peeters, R. P.
- Affiliations
- Erasmus MC (NL)
- Division of Endocrinology Department of Internal Medicine Erasmus MC Rotterdam the Netherlands
- Erasmus MC Cancer Institute (NL)
- Charité – Universitätsmedizin Berlin (DE)
- Corresponding author
- Massolt, E.T.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2016-06-13
- Volume
- 85
- Issue
- 5
- Pages
- 781-788
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2385280152
- Cited by
- 47
- References
- 16
- Citations by year
- 2025: 5 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 6 · 2020: 2 · 2019: 9 · 2018: 5 · 2017: 7 · 2016: 1
- FWCI
- 7.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- Zon-MW TOP (91212044)
- DFG Grants Priority Programme
- Erasmus MC MRACE (1629)
- Thyroid Trans Act (KO-922/17-1/2)
- DFG Graduate Programme (GRK 1208/2 TP 3)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- thyroid hormone metabolites, quality of life, levothyroxine monotherapy, differentiated thyroid cancer, hypothyroidism, 3,5-diiodo-L-thyronine, reverse T3, T4/T3 ratio, thyroid function tests, fatigue, total thyroidectomy, radioiodine ablation, athyreosis
- MeSH terms
- Fatigue, Female, Humans, Male, Middle Aged, Quality of Life, Thyroid Function Tests, Thyroid Hormones, Thyroid Neoplasms, Thyroxine, Triiodothyronine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
